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Biomedical subjects

F C Hiller

Publications and source records attributed to F C Hiller.

At least 37 records · Page 2Linked to original sources
PubMed1987

Management of tetanus.

Two cases of tetanus are presented, and the diagnosis, clinical features, and management of tetanus are reviewed. The first patient, an 86-year-old woman, had marked muscle rigidity but was able to breathe spontaneously. A dark eschar with purulent drainage was noted on her left foot, but Clostridium tetani was not isolated. She was placed in a semidark room and was treated with penicillin G; tetanus immune globulin (TIG) 5000 units i.m.; tetanus toxoid 0.5 mL i.m.; diazepam, chlorpromazine, and morphine for sedation, muscle relaxation, and analgesia; ranitidine for stress ulcer prophylaxis; heparin for prevention of deep-vein thrombosis; and peripheral-vein nutrition. Her condition improved gradually, and she was discharged to a rehabilitation institute after 32 days. The second patient, a 46-year-old woman, experienced progressive descending paralysis and required ventilatory support. She had a periodontal abscess, but cultures of the drainage were negative. She was placed in a semidark room and treated with erythromycin, TIG, tetanus toxoid, diazepam, pancuronium bromide, morphine, ranitidine, and heparin. Autonomic instability occurred during the second and third weeks, but cardiac output was maintained without treatment. The patient was extubated after five weeks, and was transferred out of the intensive-care in the following week. The diagnosis of tetanus is based primarily on characteristic findings of muscle rigidity and reflex spasms; cultures for C. tetani are of limited value. A history of trauma or injury is common. Pulmonary infections and cardiovascular instability are the most common complications. Therapy consists of ventilatory support; control of neuromuscular symptoms with benzodiazepines, narcotics, and neuromuscular blockers; antibiotic therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1986

Postoperative evaluation of sleep apnea after uvulopalatopharyngoplasty.

Uvulopalatopharyngoplasty (UPPP) is an operation that is frequently performed for the treatment of obstructive sleep apnea (OSA). While UPPP usually eliminates or decreases snoring and often reduces excessive daytime sleepiness, the decrease in the number of episodes of apnea and hypopnea, and the improvement in oxygen saturation (SaO2) have been less predictable. We compared preoperative and postoperative polysomnography (PSG) in 27 patients with OSA and found that no single PSG parameter could accurately reflect the changes in respiration seen after UPPP. We suggest that a combination of indices including the apnea index, the apnea and hypopnea index, the frequency and severity of decreases in SaO2, and the lowest SaO2 be used to assess the effect of UPPP. Using this combination we determined that 30% of our patients were markedly improved, 33% were somewhat improved, and 37% were unimproved. To rely solely on the patient's subjective improvement often results in overestimating the therapeutic results of surgery, whereas to rely only on one PSG parameter may underestimate or overestimate the degree of improvement.

Adult↗
PubMed1985

Quantitative deposition of ultrafine stable particles in the human respiratory tract.

Theoretical models of particle deposition in the respiratory tract predict high fractional deposition for particles of less than 0.1 micron, but there are few confirming experimental data for those predictions. We have measured the deposition fraction of a nonhygroscopic aerosol in the human respiratory tract. The aerosol had a count mean diameter of 0.044 micron SD of 1.93, as measured with an electrical aerosol analyzer, and was produced from a 0.01% solution of bis(2-ethylhexyl) sebacate using a condensation generator. Subjects inhaled the aerosol using a controlled respiratory pattern of 1 liter tidal volume, 12/min. Deposition was calculated as the difference in concentration between inhaled and exhaled aerosol of five size fractions corrected for system deposition and dead-space constants. Three deposition studies were done on each of five normal male volunteers. Means (+/- SE) for the five size fractions were 0.024 micron, 0.71 +/- 0.06; 0.043 micron, 0.62 +/- 0.06; 0.075 micron, 0.53 +/- 0.05; 0.13 micron, 0.44 +/- 0.04; and 0.24 micron, 0.37 +/- 0.06. These data demonstrate that deposition of inhaled particles in the 0.024- to 0.24-micron size range is high and increases with decreasing size. These observations agree with and validate predictions of mathematical models.

Adult↗
PubMed1985

Sleep apnea and the Arnold-Chiari malformation.

We present a polysomnogram-documented report of central sleep apnea (427 events) and moderately severe decreases in arterial oxygen saturation (to 81%) associated with the Arnold-Chiari malformation (ACM). Daytime hypersomnolence and other symptoms had significantly impaired our patient's work performance. After surgical correction of the ACM, there was marked improvement in symptomatology. A post-surgery polysomnogram revealed marked improvement in the number of central apneas (74 events) and only mild decreases in oxygen saturation (to 94%).

Arnold-Chiari Malformation↗
PubMed1984

Concentration and particle size distribution in smoke from marijuana cigarettes with different delta 9-tetrahydrocannabinol content.

Particle size and mass concentration are important determinants of site and quantity of respiratory tract deposition of aerosols. Particle concentrations and size distributions of smoke from marijuana cigarettes with different concentrations (as measured in the marijuana leaf) of delta 9-tetrahydrocannabinol (delta 9-THC) were measured using a single particle aerodynamic relaxation time (SPART) analyzer. The SPART analyzer measures aerodynamic diameter of single suspended particles at a rate of 3000/min. Cigarettes were smoked using a 35-cc, 2-sec puffing device attached to a diluter; dilution and analysis were completed within 4 sec of puff generation. The size distribution of smoke from all marijuana cigarettes was similar to that for tobacco cigarettes, ranging from 0.35 to 0.43 micron (count median aerodynamic diameter). The particle number and mass concentration increased as delta 9-THC concentration increased, being, respectively, 2.2- and 3.8-fold higher in the marijuana cigarette leaf with highest delta 9-THC concentration compared to the placebo marijuana cigarette. These data indicate the need for quantitative comparisons of other potentially toxic constituents in marijuana cigarettes of different delta 9-THC concentrations.

Cannabis↗
PubMed1984

Deposition of sidestream cigarette smoke in the human respiratory tract.

The intake of sidestream cigarette smoke can be calculated if ventilation and smoke concentration are known. However, respiratory tract dose of smoke particulates cannot be determined unless the deposition fraction of inhaled smoke is known. The deposition fraction of mainstream smoke is 70-90%, far higher than expected for most particles in the size range, 0.2-0.5 micron, which is also the range for cigarette smoke. The deposition fraction of sidestream smoke was measured in five normal male subjects. The deposition, the dose of smoke particulates to the respiratory tract can be estimated. The deposition fraction of sidestream smoke is much lower than for mainstream smoke.

Humans↗
PubMed1983

Evaluation and management of acute asthma.

Successful management of asthma requires an expectant, aggressive approach to asthma attacks as well as a careful management program to maintain remissions. The patient must recognize when he or she needs help, and the physician must be able to assess the severity of deterioration and provide rapid aggressive care. Failures are usually due to patient or physician error, or both. These relate to failures both outside and inside the hospital. Once inside the hospital, failure is mainly the responsibility of the physician. It is clear that deaths in the hospital have been associated with inadequate patient observation and monitoring, and treatment that is less aggressive than required. With appropriate patient and physician education and aggressive management, deaths during acute asthma attacks should be rare.

Acute Disease↗
PubMed1982

Haemophilus influenzae infection of an existing lung cyst.

Although Haemophilus influenzae is becoming recognized as a cause of serious pulmonary infections in adults, it has not been previously reported to infect lung cysts. We describe a 25-year-old man who had a lung cyst in which a serious infection developed. Both needle aspiration of the cyst and blood culture confirmed that the infection was caused by H influenzae.

Adult↗
PubMed1982

Deposition of sidestream cigarette smoke in the human respiratory tract.

Measurement of deposition of sidestream cigarette smoke in the human respiratory tract is important for assessing the health effects of sidestream cigarette smoke. We measured the deposition fraction of sidestream cigarette smoke in 5 normal adult male volunteers using sidestream smoke at a concentration similar to that encountered indoors with smokers present. The mean deposition was 11%. These data indicate that the deposition fraction of sidestream smoke is similar to other previously studied aerosols in the same size range and is much less than mainstream smoke.

Adult↗
PubMed1982

Ibuprofen in canine endotoxin shock.

The participation of prostaglandins in the physiologic alterations of endotoxin shock has been well established with the aid of prostaglandin synthetase inhibitors. Our study was designed to investigate the potential of ibuprofen, a highly specific cyclooxygenase inhibitor, to reverse the hemodynamic and acid base abnormalities of canine endotoxin shock. Mean blood pressure fell to 49.8 +/- 6.6 mm Hg in dogs given endotoxin by 5 min after injection, and remained below 83 mm Hg for the duration of the 120-min observation period. In animals given endotoxin followed by ibuprofen, a similar initial drop of systemic blood pressure was seen, but it subsequently recovered to 150.2 +/- 4.1 mm Hg by 120 min (P less than 0.001). Cardiac index increased in animals given ibuprofen (2.3 +/- 0.28 liter/m2 per min) compared with animals given endotoxin alone (1.0 +/- 0.09 liter/m2 per min) by termination of the experiment. The arterial pH dropped in endotoxin treated animals to 7.18 +/- 0.03 by 120 min. Ibuprofen prevented the acidosis, the final pH in ibuprofen and endotoxin treated animals measuring 7.36 +/- 0.01. We conclude that ibuprofen protects against the hypotension, acidosis, and depression of cardiac index of canine endotoxin shock.

Animals↗
PubMed1981

Physical properties of therapeutic aerosols.

This work describes results of measurements made to determine the size distribution of commonly used medical aerosols and the effect of high humidity on size distribution of some of those aerosols. If therapeutic aerosol particles change size considerably at high humidity, deposition quantity and site in the respiratory tract could be altered. If there is little change in size at high humidity, deposition could be estimated using theoretical deposition methods devised for deposition of stable particles. The results of this work suggest that the aerosol produced by most metered dose bronchodilator devices does not change size very much at high humidity.

Aerosols↗
PubMed1980

Effect of low and high relative humidity on metered-dose bronchodilator solution and powder aerosols.

Physical properties of two metered-dose bronchodilator aerosols packaged as solutions and two aerosols packaged as finely ground powders were measured at low and high relative humidity. The aerodynamic size distribution and particle concentration were measured in real time using the single-particle aerodynamic relaxation time analyzer, which can measure the aerodynamic diameter of single suspended particles in the respirable size range. The count median aerodynamic diameter, the mass per dose were calculated. Significant increases were noted in the count median aerodynamic diameter, the total particles per dose, and the total aerodynamic mass median aerodynamic diameter for three aerosols and in the mass median aerodynamic diameter for two aerosols. The number of particles in the measured size range increased 3.6- and 4.1-fold for the droplet aerosols and 1.4-fold for the powder preparations. The aerodynamic mass per dose in the measured size range increased 5.7- and 11.4-fold for the droplet aerosols and 3.1- and 1.6-fold for the powder aerosols. These data indicate that all aerosols tested increased in size at high humidity and that aerosols dispensed as droplets may be more unstable than those dispensed as powders.

Aerosols↗
PubMed1980

Intracavitary amphotereicin B in the treatment of symptomatic pulmonary aspergillomas.

The optimal treatment of pulmonary aspergillomas is not established. Surgical resection is often impossible because of severe, underlying pulmonary impairment, and medical treatment has given negative or inconclusive results. Six patients with symptomatic pulmonary aspergillomas were treated with percutaneous instillation of intracavitary amphotericin B. Four patients who received the full course of therapy showed improvement and stabilization or reversal of progressive roentgenographic changes. Also, follow-up serologic studies of Aspergillus spp. precipitins were obtained in three and were negative. One patient did not tolerate this treatment because of repeated systemic reactions. Another patient did not respond clinically or roentgenographically. Intracavitary amphotericin B therapy should be considered in patients with symptomatic pulmonary aspergilloma, particularly when surgical resection is not feasible.

Adult↗